In-person Group Research Articles

Telehealth Treatment of Patients with Bipolar Depression during the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness to Prepandemic In-person Treatment

Introduction The COVID-19 pandemic prompted a transition from in-person to telehealth psychiatric treatment. There are no studies of partial hospital telehealth treatment for bipolar disorder.ObjectivesIn the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the effectiveness of partial hospital treatment of patients with bipolar depression treated virtually versus in-person.MethodsOutcome was compared in 76 patients with bipolar depression who were treated virtually from April, 2020 to December, 2022 to 130 patients who were treated from May, 2017 to January 2020. The patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being.ResultsIn both the in-person and telehealth groups patients with bipolar depression were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups also reported a significant improvement in positive mental health, general well-being, coping ability, and functioning. Suicidal ideation was reduced in both groups. No patients attempted suicide. A large effect size of treatment was found in both treatment groups. The length of stay and the likelihood of staying in treatment until completion were significantly greater in the virtually treated patients.ConclusionsTelehealth delivery of partial hospital level of care for patients with bipolar depression was as safe and effective as in-person treatment.Disclosure of InterestNone Declared

The efficacy of a virtual and in-person mindfulness-based intervention course on university students’ during COVID-19 pandemic

Objective: The purpose of this research was to evaluate the impact of a mindfulness-based intervention (MBI) on university students during the COVID-19 pandemic. Methods and participants: There were 53 participants who voluntarily enrolled in a mindfulness course at a regional state university (24 virtual and 29 in-person) and 56 in the control group. Participants completed surveys at the beginning and end of the course on mindfulness, life satisfaction, and resilience. Results: Results revealed that the in-person group showed significantly higher mindfulness, life satisfaction, and resilience over the course of the semester. The virtual group showed increases across all three variables as well, but only significantly improved on resilience. Conclusion: Results indicate that the inclusion of MBIs in university courses may be a cost-effective and proactive means to support the mental health and well-being of college students, and that in-person delivery may be a more effective modality.

Exploring the Impact of Web-Based vs. In-Person Exercise Training on Benefits and Adherence in Substance Use Disorder Interventions: A Pilot Study.

Substance use disorders pose unique challenges, affecting individuals physiologically and socially. This study addresses the fundamental question of how adherence to exercise programs impacts those with substance use disorders, examining both in-person and online interventions. A 12-week analysis involving 26 participants assessed physical fitness, strength, and quality of life. Participants were categorized into in-person and online exercise groups, with their adherence tracked through attendance and a dedicated app. The in-person group exhibited higher adherence rates and significant improvements, in contrast to the challenges encountered by the online groups, particularly in substance use disorder cohorts. Statistical analyses highlighted these differences, emphasizing the pivotal role of the exercise program delivery format. This research advocates for hybrid models, blending professional supervision with online flexibility, recognizing the distinct challenges of substance use disorders. Insights from this study will contribute to shaping more effective, personalized interventions in the complex landscape of substance use disorders, offering guidance for advancing treatment strategies.

Exploring the effectiveness of virtual and in-person instruction in culinary medicine: a survey-based study

BackgroundCulinary medicine, which has recently increased in popularity in medical education, incorporates food and nutritional interventions with principles of disease prevention and treatment. The ultimate goal is to improve overall health outcomes. The growing prevalence of diet-related chronic diseases indicates the need for physicians to have a deeper understanding of the interplay between nutrition and disease. Incorporating culinary medicine into medical education can equip medical students with the necessary skills and knowledge to promote better patient outcomes. The purpose of this study was to evaluate students’ perceptions of their foundational knowledge of a culinary medicine course after completion of the course for first- and second-year medical students at the PCOM (Philadelphia College of Osteopathic Medicine). We will also examine the difference between methods of instruction in relation to constructs discussed of knowledge gained and enjoyment of the course.MethodsThis retrospective cohort study was conducted using SurveyMonkey by Momentive. Data were collected from osteopathic medical students who enrolled in a culinary medicine course at the PCOM from 2018 to 2022 through the completion of a post-course survey. The methods of instruction included either a virtual or in-person classroom. The statistical analysis for this study was conducted using IBM SPSS Statistics version 28. To compare methods of instruction, the statistical analyses used included descriptive statistics, chi-square analysis, one-way ANOVA, and independent sample one-sided t tests.ResultsA total of 360 out of 430 participants, spanning the years 2018 to 2022, completed the course requirements and participated in the online survey. There was a valid sample size of 249 for the in-person group and 111 for the virtual instruction group. The knowledge gained construct consisted of five survey questions, for a total possible score of 25, while the enjoyment construct consisted of two questions, for a total possible score of 10. A statistically significant difference in knowledge gained was identified by one-way ANOVA, F (4,355) = 3.853, p =.004. Additionally, there was a statistically significant difference in enjoyment of the course between class years, F (4,356) = 11.977, p <.001. Independent sample t-tests revealed a statistically significant difference in enjoyment between the two methods (p <.001) even after accounting for unequal variances, with Cohen’s d equal to 0.807, indicating a moderate effect size.ConclusionsThe findings of this study suggest that overall, students were highly satisfied with the Culinary Medicine course over a five-year period. The study suggested that students who participated in in-person courses benefitted more than did the virtual students in terms of knowledge gained and enjoyment. The 360 students who completed the Culinary Medicine course were highly satisfied with the information and skills they acquired.

Medical Nutrition Therapy, In-Person, or Telephone Group Lifestyle Intervention for Type 2 Diabetes? A Qualitative Study of Patient Perceptions and Treatment Preferences.

The purpose of the study was to explore the thoughts, feelings, motivations, and assignment preferences of community health center patients with type 2 diabetes considering participation in a 2-year lifestyle intervention trial aimed at weight loss and increased physical activity. The reasons for patients' delivery mode preferences were also explored to aid in the design of future interventions for controlled trials. Using structured telephone interview guides, 57 patients with type 2 diabetes receiving primary care at 3 community health centers affiliated with an academic medical center were interviewed regarding the perceived pros and cons of each of the 3 possible treatment assignments: telephone conference group, in-person group, or individual medical nutrition therapy. The interview data were organized using NVIVO and analyzed using content analysis. Findings on whether preferences varied by age, gender, or diabetes duration were also examined. Six categories related to patient treatment preferences were identified: (1) perception of time, (2) learning style, (3) comfort, (4) prior experience with weight loss programs and conference calls, (5) desire for support/idea exchange, and (6) accountability. Preferences did not seem to vary by age, gender, or diabetes duration. Key factors influencing preference of treatment assignment included schedule demands, belief about learning style, and past experiences. These findings demonstrate the importance of having a variety of nutrition and lifestyle treatment options available to meet the needs of people with type 2 diabetes.

In-hospital stroke protocol outcomes before and after the implementation of neurological assessments by telemedicine: an observational case-control study.

Stroke is the second leading cause of global adult mortality and the primary cause of disability. A rapid assessment by a neurologist for general and reperfusion treatments in ischemic strokes is linked to decreased mortality and disability. Telestroke assessment is a strategy that allows for neurological consultations with experienced professionals, even in remote emergency contexts. No randomized studies have compared face-to-face neurological care outcomes with telestroke care. Whether neurologists in an institution achieve better results remotely than in person is also unknown. This study aimed to compare mortality and other outcomes commonly measured in stroke protocols for stroke patients assessed by a neurologist via face-to-face evaluations and telestroke assessment. Observational single-center retrospective study from August/2009 to February/2022, enrolling 2,689 patients with ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage. Group 1 (G1) comprised 2,437 patients with in-person neurological assessments, and Telemedicine Group 2 (G2) included 252 patients. The in-person group had higher admission NIHSS scores (G1, 3 (0; 36) vs. G2, 2 (0; 26), p < 0.001). The door-to-groin puncture time was lower in the in-person group than in the telestroke group (G1, 103 (42; 310) vs. G2, 151 (109; 340), p < 0.001). The telestroke group showed superior metrics for door-to-imaging time, symptomatic hemorrhagic transformation rate in ischemic stroke patients treated with intravenous thrombolysis, hospital stay duration, higher rates of intravenous thrombolysis and mechanical thrombectomy, and lower mortality. Symptomatic hemorrhagic transformation rate was smaller in the group evaluated via telestroke (G1, 5.1% vs. G2, 1.1%, p = 0.016). Intravenous thrombolysis and mechanical thrombectomy rates were significantly higher in telestroke group: (G1, 8.6% vs. G2, 18.2%, p < 0.001 and G1, 5.1% vs. G2, 10.4%, p = 0.002, respectively). Mortality was lower in the telestroke group than in the in-person group (G1, 11.1% vs. G2, 6.7%, p = 0.001). The percentage of patients with an mRS score of 0-2 at discharge was similar in both groups when adjusting for NIHSS score and age. The same neurological emergency team may assess stroke patients in-person or by telemedicine, with excellent outcome metrics. This study reaffirms telestroke as a safe tool in acute stroke care.

Transfusion Camp Rwanda 2023: A train-the-trainer workshop establishing locally driven leadership in knowledge translation and sustainability in transfusion medicine education.

Blood transfusion is performed daily in hospitals. Gaps exist between transfusion guidelines and day-to-day clinical care. These gaps are prevalent in resource-limited settings due to scarce continuing medical education. Transfusion Camp Rwanda aims to bridge this gap by (1) delivering context-appropriate up-to-date education, (2) teaching participants how to independently deliver a case-based curriculum and (3) identifying strategies to promote change in transfusion practice in Rwanda. In May 2023, a multidisciplinary team from Canada and Rwanda carried out a Transfusion Camp train-the-trainer workshop for clinicians from all five provinces in Rwanda. Participants attended in-person lectures, seminars and workshop group discussions on the implementation of the Rwanda National Directives on Rational Use of Blood and Blood Components. Course feedback was based on the Kirkpatrick Model of Training and Evaluation. Fifty-one physicians and laboratory technicians participated in the course. Confidence in caring for patients based on transfusion guidelines was self-rated as 'excellent' by 23% of participants before and 77% after, while 84% reported they planned to teach Transfusion Camp to others and 100% responded that they will apply course content to clinical practice. Workshop groups recommended strategies to improve transfusion medicine practice in Rwanda in four domains: Communication, Institutional Approval, Practice Audits and Education. Transfusion medicine education in Rwanda using a train-the-trainer approach was well-received by participants and allowed for a more detailed understanding of the local medical and educational environment. These observations can inform the further expansion of the Transfusion Camp Rwanda project.

'If he thought that I was going to go and hurt myself, he had another thing coming': Treatment experiences of those with large to massive rotator cuff tears and the perspectives of healthcare practitioners.

To explore the treatment experiences of those diagnosed with large to massive rotator cuff tears and the perspectives of healthcare practitioners providing their care. A qualitative descriptive study using reflexive thematic analysis. In-person focus groups were undertaken in a clinical setting (private practice [n = 1]; public outpatient [n = 2]). Semi-structured interviews were conducted online via Microsoft Teams. Patients diagnosed with these tears (n = 12) and healthcare practitioners (n = 11). Two interlinking themes were identified based on the care received and provided for patients with symptomatic large to massive rotator cuff tears:1) Positive treatment experiences and management: Education, clear communication and reassurance around prognosis were the foundation of positive patient-clinician care. Sub-themes of pain relief, exercise prescription and confidence in their pathway underpinned this experience. This proficiency in care was affirmed by some healthcare practitioners who spoke about the importance of confidence and experience in their management plan even in times of poor progress.2) Negative treatment experiences and management: Uncertainty, delays and exacerbation of pain flawed the patient-clinician care. Sub-themes of inappropriate pain relief, inappropriate exercise prescription and uncertainty impacted their care. Some healthcare practitioners acknowledged knowledge gaps led to uncertainty especially when choosing the next step of care and were quick to escalate care to deflect this uncertainty. The findings suggest discordance exists between the patient's experiences and expectations when the delivery of care was by less experienced and confident healthcare practitioners in the management of this condition. This highlights the need for improved education and support for healthcare practitioners.

Evaluating the Impact of Teledentistry on Patient Outcomes, Diagnostic Accuracy, and Satisfaction in a Prospective Observational Analysis.

Background Teledentistry, defined as the use of telecommunication technologies for dental care, has emerged as a transformative approach to oral health services. This prospective observational analysis aims to comprehensively assess the impact of teledentistry on patient outcomes and satisfaction, addressing key aspects such as diagnostic accuracy, longitudinal treatment outcomes, and economic and logistical considerations. Methods The study involved 242 participants selected from diverse dental clinics offering teledentistry services. Participants could choose between traditional in-person visits and teledentistry consultations. The teledentistry interventions included remote consultations, diagnostic evaluations, and treatment planning facilitated through virtual communication tools. Baseline assessments captured initial dental conditions, and follow-up assessments were conducted at three, six, and 12 months. Outcome measures included diagnostic accuracy, patient satisfaction, changes in dental conditions over time, and economic and logistical feedback. Results Descriptive statistics revealed baseline characteristics, with participants evenly distributed between in-person and teledentistry groups. However, the overall satisfaction with diagnoses was significantly lower in the teledentistry group as compared to the in-person group (p < 0.001). Longitudinal assessments demonstrated comparable changes in dental conditions between the two groups. Economic feedback highlighted a cost-saving advantage for teledentistry users, with 80% reporting reduced expenses. Conclusion This study highlights the transformative potential of teledentistry in expanding access to oral health services, reducing costs, and providing comparable treatment outcomes to traditional in-person care. Future efforts should focus on enhancing the teledentistry experience, addressing patient satisfaction concerns, and refining the delivery of remote dental care to maximize its benefits for both patients and healthcare systems.

Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups

BackgroundCardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence.MethodsAn interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified.ResultsTwo in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system.ConclusionsAdhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Understanding perceptions of tumor genomic profile testing in Black/African American cancer patients in a qualitative study: the role of medical mistrust, provider communication, and family support.

Tumor genomic profiling (TGP) examines genes and somatic mutations specific to a patient's tumor to identify targets for cancer treatments but can also uncover secondary hereditary (germline) mutations. Most patients are unprepared to make complex decisions related to this information. Black/African American (AA) cancer patients are especially at risk because of lower health literacy, higher levels of medical mistrust, and lower awareness and knowledge of genetic testing. But little is known about their TGP attitudes or preferences. Five in-person focus groups were conducted with Black/AA cancer patients (N = 33) from an NCI-designated cancer center and an affiliated oncology unit in an urban safety-net hospital located in Philadelphia. Focus groups explored participants' understanding of TGP, cultural beliefs about genetics, medical mistrust, and how these perceptions informed decision-making. Participants were mostly female (81.8%), and one-third had some college education; mean age was 57 with a SD of 11.35. Of patients, 33.3% reported never having heard of TGP, and 48.5% were not aware of having had TGP as part of their cancer treatment. Qualitative analysis was guided by the principles of applied thematic analysis and yielded five themes: (1) mistrust of medical institutions spurring independent health-information seeking; (2) genetic testing results as both empowering and overwhelming; (3) how provider-patient communication can obviate medical mistrust; (4) how unsupportive patient-family communication undermines interest in secondary-hereditary risk communication; and (5) importance of developing centralized patient support systems outside of treatment decisions. Results improve understanding of how Black/AA patients perceive of TGP and how interventions can be developed to assist with making informed decisions about secondary hereditary results.

Cognitive and immunological effects of yoga compared to memory training in older women at risk for alzheimer’s disease

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) accompanied by cerebrovascular risk factors (CVRFs) are known to increase the risk of developing dementia. Mind-body practices such as yoga and meditation, have been recognized as safe techniques with beneficial effects on cognitive functions in older adults at risk for cognitive decline. We conducted a randomized, controlled trial to assess the efficacy of Kundalini yoga training (KY) compared to memory enhancement training (MET) on mood and cognitive functioning in a group of older women with CVRFs and SCD (clinicaltrials.gov = NCT03503669). The KY intervention consisted of weekly, 60-min in-person classes with a certified instructor for 12 weeks, with a 12-min guided recording for daily homework practice at home. MET involved 12 weekly in-person group classes with 12-min daily homework exercises. Objective and subjective memory performance were the primary outcomes. Peripheral whole blood samples were collected at baseline, 12-weeks, and 24-weeks follow-up for RNA sequencing and cytokine/chemokine assays. A total of 79 patients (KY = 40; MET = 39) were randomized, and 63 completed the 24-week follow-up (KY = 65% completion rate; MET = 95%; χ2(1) = 10.9, p < 0.001). At 24-weeks follow-up, KY yielded a significant, large effect size improvement in subjective cognitive impairment measures compared to MET. KYOn a transcriptional level, at 12- and 24-week follow-up, KY uniquely altered aging-associated signatures, including interferon gamma and other psycho-neuro-immune pathways. Levels of chemokine eotaxin-1, an aging marker, increased over time in MET but not KY participants. These results suggest clinical and biological benefits to KY for SCD, linking changes in cognition to the anti-inflammatory effects of yoga.

Comparison of Telemedicine versus In-Person Visit for Control of Asthma in Children aged 7-17years: A Randomized Controlled Trial.

To compare asthma control between telemedicine and in-person visit in children aged 7 to 17 y. A non-inferiority randomized-controlled trial was conducted at a pediatric chest clinic, involving a total of 192 patients, with 96 children in each group of telemedicine and in-person follow-up. There was a significant improvement in the mean asthma control test (ACT)/ Childhood asthma control test (C-ACT) scores from baseline to three months in both groups, with no significant difference in the change of means between the two groups. The mean difference in ACT/C-ACT score at three months in the telemedicine and in-person visit group was -0.35; 95% CI (-1.30 to +0.10) [p-value 0.09]. There was a significant change in the mean Pediatric Quality of Life index (PQLI) scores from 57.2 ± 10.2 to 66.82 ± 7.99 in the telemedicine group and from 56.1 ± 11.7 to 66.71 ± 4.66 in the in-person visit group, however the mean difference in PQLI score in both the groups was not significant (p = 0.91). There was no significant difference in the number of asthma exacerbations (4 vs. 1) between telemedicine and in-person visit (p = 0.10). The mean telemedicine satisfaction questionnaire score in this study was 3.8 ± 0.7, which indicates that most of the parents were satisfied with the telemedicine follow-up process. This study revealed that telemedicine is non-inferior to in-person visit for follow-up of children with asthma and can be used as an alternative to in-person visit for the management of asthma, especially in remote settings and pandemic situations.

Prospective evaluation of parent and child outcomes following admission to a ‘virtual’ early parenting residential programme

ObjectivesAustralian early parenting residential services provide interventions for families experiencing complex early parenting issues. Many services have recently shifted to virtual care models but the clinical effectiveness of such programmes...

Effectiveness of Online vs. In-Person Periodontal Health Workshops for Public Awareness

ABSTRACT Background: Periodontal health is a critical aspect of overall oral health, yet public awareness and education on this topic remain limited. With the increasing prevalence of online health education platforms, it is essential to evaluate the effectiveness of online periodontal health workshops compared with traditional in-person workshops on improving public awareness Materials and Methods: Study Design: This randomized controlled trial (RCT) aimed to assess the impact of online and in-person periodontal health workshops on public awareness. Participants (N = 500) were randomly assigned to one of two groups: the online workshop group or the in-person workshop group. Online Workshop: Participants in this group accessed an interactive online periodontal health workshop, consisting of video presentations, animations, and quizzes. The workshop covered topics, such as gum disease prevention, oral hygiene, and the importance of regular dental checkups. In-Person Workshop: Participants in this group attended a traditional in-person periodontal health workshop conducted by dental professionals. The content and duration of this workshop mirrored the online version. Pre- and Postworkshop Assessments: Both groups completed pre-workshop and postworkshop assessments, including a knowledge questionnaire and a self-assessment of oral health habits. Arbitrary scores were assigned to quantify knowledge gain (0–100%). Results: Participants in the online workshop group showed a mean knowledge gain of 30% (standard deviation (SD) = 5.2), while those in the in-person workshop group exhibited a mean knowledge gain of 35% (SD = 4.7). The self-assessment of oral health habits indicated an improvement in both groups, with 60% of participants reporting better oral hygiene practices Conclusion: Both online and in-person periodontal health workshops demonstrated effectiveness in improving public awareness and promoting better oral health habits. Combining both modalities could be an effective strategy for comprehensive public education on periodontal health.

Online versus in-person surgical near-peer teaching in undergraduate medical education during the COVID-19 pandemic: A mixed-methods study.

The coronavirus disease 2019 (COVID-19) pandemic stimulated a paradigm shift in medical and surgical education from in-person teaching to online teaching. It is unclear whether an in-person or online approach to surgical teaching for medical students is superior. We aim to compare the outcomes of in-person versus online surgical teaching in generating interest in and improving knowledge of surgery in medical students. We also aim the quantify the impact of a peer-run surgical teaching course. A six-session course was developed by medical students and covered various introductory surgical topics. The first iteration was offered online to 70 UK medical students in March 2021, and the second iteration was in-person for 20 students in November 2021. Objective and subjective knowledge was assessed through questionnaires before and after each session, and also for the entire course. Data were analyzed from this mixed-methods study to compare the impact of online versus in-person teaching on surgical knowledge and engagement. Students in both iterations showed significant improvement of 33%-282% across the six sessions in knowledge and confidence after completing the course (p < 0.001). There was no significant difference in the level of objective knowledge, enjoyment, or organization of the course between online and in-person groups, although the in-person course was rated as more engaging (mean Likert score 9.1 vs. 9.7, p = 0.033). Similar objective and subjective surgical teaching outcomes were achieved in both iterations, including in "hands-on"topics such as suturing, gowning, and gloving. Students who completed the online course did not have any lower knowledge or confidence in their surgical skills;however, the in-person course was reported to be more engaging. Surgical teaching online and in-person may be similarly effectiveand can be delivered according to what is most convenient for the circumstances, such as in COVID-19.

Comparing Online and In-Person Delivery of a Fall Prevention Exercise Program for Older Adults.

Exercise is the single most effective strategy to reduce the risk of falls. Online classes have grown in popularity, but the benefits of online classes remain unknown. Zoomers on the Go is a peer-led 12-week exercise program offered twice weekly to adults 50+years old. The main outcome was lower body strength measured by the 30-s chair stand test. Other outcomes included dropout, attendance, balance, cardiorespiratory fitness, and perceived health. A total of 74 participants (age 66.3 ± 7.1years) in the online group and 84 participants in the in-person group (age 67.3 ± 7.2years) completed the program, with attendance for the online group. Both groups significantly improved their 30-s chair stand, cardiorespiratory fitness, and balance (p < .001) with no difference in functional benefits between groups. The in-person group improved their perceived health and significantly reduced levels of stress and depression, while no such changes were observed in the online group.

Assessing stakeholders' opinions on sharing antimicrobial susceptibility testing data from animals is key to developing a centralized database and dashboard tool.

To present, analyze, and discuss stakeholders' opinions regarding sharing antimicrobial susceptibility testing (AST) data from animals into a centralized database and dashboard tool that would collect, aggregate, store, and analyze this type of data from veterinary diagnostic laboratories (VDLs) across the country. 1 in-person focus group (9 participants), 9 virtual focus groups (49 participants), and online pre- and postmeeting surveys (76 and 35 participants, respectively). Focus groups and surveys were conducted to assess the opinions of veterinarians, producers, researchers, diagnosticians, and government officials. A strong majority of stakeholders recognize AMR as a serious concern for both human and animal health and see several benefits in establishing a centralized AMR database; however, several concerns were raised associated with data confidentiality, security, curation, and harmonization. In the interest of alleviating those concerns, among other items, stakeholders suggested education and training of data users, providers, and the public in addition to assuring strong data confidentiality protections. Stakeholder engagement is a critical component of all stages of development, implementation, and utilization of an AMR database and dashboard tool that could be used to inform antimicrobial stewardship in veterinary medicine. This assessment of stakeholders' needs and concerns can be used to help guide future recommendations for data legal protections as well as a data confidentiality and security framework. Maintaining open communication on data usage, storage, and security as well as involvement and education of data providers, users, and the public will remain key to enabling development of an AMR database and dashboard tool for domesticated animals.

Abstract WP95: The Effectiveness of Remote Informed Consent for Clinical Intervention in the Setting of Acute Ischemic Stroke

Background: Informed consent is an essential part of current medical practice which protects the patient’s right to make an informed decision with sufficient understanding of the risks and the benefits of any medical intervention. Because of the need to provide care quickly, consent is often obtained remotely in acute ischemic stroke. Currently, to our knowledge, no study has provided a direct measurement of effectiveness of remote consent compared to in-person consent. In this study, we surveyed those providing consent for thrombolysis and thrombectomy for satisfaction with the consent process. We also compared in person and remote consent for effectiveness in understanding of the intervention. Methods: We conducted post-consent surveys of the person consenting to either thrombolysis or thrombectomy (patient or their legally authorized representative). Surveys assessed satisfaction with the consent process including if the explanation of the procedure was clear and if they had comfortable level of understanding. Survey also included self- and objective assessments of the information provided. Patients who received thrombolysis via wake-up protocol, or as part of another research study, were excluded. Results: A total of 86 surveys assessing 61 remote and 25 in-person consents were analyzed. The in person consents were 56% thrombectomy, while remote consents were 97% thrombectomy. Both in-person and remote groups had high satisfaction rate (9.72/10 vs 9.44/10, P = 0.301) and high self-assessment of understanding (2.56/3 vs 2.74/3, P = 0.11). Objective assessment testing consenter’s knowledge of the procedure showed slightly lower performance for in-person consent, although this was statistically not significant (91% vs 93%, P= 0.17). Further analysis excluding self-consents showed no difference in the two groups (92% vs 94%, P = 0.77). Conclusion: Our observational study showed that patient and legal authorized representatives had a similarly satisfactory experience and understanding when consenting to thrombolysis/thrombectomy when consented in person compared to remote consent.

Exploring the experiences and preferences of South Asian patients' of primary care in England since COVID-19.

Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operateon a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care. Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data. Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choiceand (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and 'hands-on' care leading to perceptions of reduced psycho-social safety. SA patients' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future. Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components.